Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group

Kenichi Harano, Akihiro Hirakawa, Mayu Yunokawa, Toshiaki Nakamura, Toyomi Satoh, Tadaaki Nishikawa, Daisuke Aoki, Kimihiko Ito, Kiyoshi Ito, Toru Nakanishi, Nobuyuki Susumu, Kazuhiro Takehara, Yoh Watanabe, Hidemichi Watari, Toshiaki Saito

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Uterine carcinosarcomas (UCSs) are rare and aggressive tumors. The prognostic factors are not sufficiently known. Methods: We performed a multi-institutional, retrospective study of women with stage I–IV UCS, diagnosed between 2007 and 2012. Data obtained from medical records included demographic, clinicopathological, treatment, and outcome information. Results: A total of 486 patients (median age 65 years) were identified—224 (46 %) were stage I, 32 (7 %) were stage II, 139 (28 %) were stage III, and 91 (19 %) were stage IV. Among them, 277 (57 %) had disease recurrence. Median disease-free survival (DFS) was 16.4 months [95 % confidence interval (CI) 15.7–27.2], and median overall survival (OS) was 72.0 months (95 % CI 43.0–not reached). In total, 454 (94 %) patients received adjuvant treatment, and 440 (91 %) received adjuvant chemotherapy. In multivariate analysis, stage III–IV disease, CA-125 level, and lymphovascular space invasion (LVSI) were significantly associated with shorter median DFS. Stage III–IV disease, performance status 2–4, ≥50 % myometrial invasion depth, and postsurgical residual tumor size >1 cm were significantly associated with shorter median OS. Conversely, pelvic lymph node lymphadenectomy was associated with improved DFS and OS. Conclusions: Stage, performance status, CA-125 level, LVSI, and myometrial invasion were associated with poor prognoses. Pelvic lymphadenectomy was associated with improved survival, and may be necessary for the surgical management of UCS.

Original languageEnglish
Pages (from-to)168-176
Number of pages9
JournalInternational Journal of Clinical Oncology
Volume21
Issue number1
DOIs
Publication statusPublished - 2016 Feb 1

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Carcinosarcoma
Retrospective Studies
Disease-Free Survival
Survival
Lymph Node Excision
Confidence Intervals
Residual Neoplasm
Adjuvant Chemotherapy
Medical Records
Multivariate Analysis
Lymph Nodes
Demography
Recurrence
Neoplasms

Keywords

  • Lymphadenectomy
  • Pelvic lymph node
  • Prognostic factor
  • Uterine carcinosarcoma

ASJC Scopus subject areas

  • Oncology
  • Surgery
  • Hematology

Cite this

Prognostic factors in patients with uterine carcinosarcoma : a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. / Harano, Kenichi; Hirakawa, Akihiro; Yunokawa, Mayu; Nakamura, Toshiaki; Satoh, Toyomi; Nishikawa, Tadaaki; Aoki, Daisuke; Ito, Kimihiko; Ito, Kiyoshi; Nakanishi, Toru; Susumu, Nobuyuki; Takehara, Kazuhiro; Watanabe, Yoh; Watari, Hidemichi; Saito, Toshiaki.

In: International Journal of Clinical Oncology, Vol. 21, No. 1, 01.02.2016, p. 168-176.

Research output: Contribution to journalArticle

Harano, K, Hirakawa, A, Yunokawa, M, Nakamura, T, Satoh, T, Nishikawa, T, Aoki, D, Ito, K, Ito, K, Nakanishi, T, Susumu, N, Takehara, K, Watanabe, Y, Watari, H & Saito, T 2016, 'Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group', International Journal of Clinical Oncology, vol. 21, no. 1, pp. 168-176. https://doi.org/10.1007/s10147-015-0859-7
Harano, Kenichi ; Hirakawa, Akihiro ; Yunokawa, Mayu ; Nakamura, Toshiaki ; Satoh, Toyomi ; Nishikawa, Tadaaki ; Aoki, Daisuke ; Ito, Kimihiko ; Ito, Kiyoshi ; Nakanishi, Toru ; Susumu, Nobuyuki ; Takehara, Kazuhiro ; Watanabe, Yoh ; Watari, Hidemichi ; Saito, Toshiaki. / Prognostic factors in patients with uterine carcinosarcoma : a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. In: International Journal of Clinical Oncology. 2016 ; Vol. 21, No. 1. pp. 168-176.
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abstract = "Background: Uterine carcinosarcomas (UCSs) are rare and aggressive tumors. The prognostic factors are not sufficiently known. Methods: We performed a multi-institutional, retrospective study of women with stage I–IV UCS, diagnosed between 2007 and 2012. Data obtained from medical records included demographic, clinicopathological, treatment, and outcome information. Results: A total of 486 patients (median age 65 years) were identified—224 (46 {\%}) were stage I, 32 (7 {\%}) were stage II, 139 (28 {\%}) were stage III, and 91 (19 {\%}) were stage IV. Among them, 277 (57 {\%}) had disease recurrence. Median disease-free survival (DFS) was 16.4 months [95 {\%} confidence interval (CI) 15.7–27.2], and median overall survival (OS) was 72.0 months (95 {\%} CI 43.0–not reached). In total, 454 (94 {\%}) patients received adjuvant treatment, and 440 (91 {\%}) received adjuvant chemotherapy. In multivariate analysis, stage III–IV disease, CA-125 level, and lymphovascular space invasion (LVSI) were significantly associated with shorter median DFS. Stage III–IV disease, performance status 2–4, ≥50 {\%} myometrial invasion depth, and postsurgical residual tumor size >1 cm were significantly associated with shorter median OS. Conversely, pelvic lymph node lymphadenectomy was associated with improved DFS and OS. Conclusions: Stage, performance status, CA-125 level, LVSI, and myometrial invasion were associated with poor prognoses. Pelvic lymphadenectomy was associated with improved survival, and may be necessary for the surgical management of UCS.",
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AU - Harano, Kenichi

AU - Hirakawa, Akihiro

AU - Yunokawa, Mayu

AU - Nakamura, Toshiaki

AU - Satoh, Toyomi

AU - Nishikawa, Tadaaki

AU - Aoki, Daisuke

AU - Ito, Kimihiko

AU - Ito, Kiyoshi

AU - Nakanishi, Toru

AU - Susumu, Nobuyuki

AU - Takehara, Kazuhiro

AU - Watanabe, Yoh

AU - Watari, Hidemichi

AU - Saito, Toshiaki

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N2 - Background: Uterine carcinosarcomas (UCSs) are rare and aggressive tumors. The prognostic factors are not sufficiently known. Methods: We performed a multi-institutional, retrospective study of women with stage I–IV UCS, diagnosed between 2007 and 2012. Data obtained from medical records included demographic, clinicopathological, treatment, and outcome information. Results: A total of 486 patients (median age 65 years) were identified—224 (46 %) were stage I, 32 (7 %) were stage II, 139 (28 %) were stage III, and 91 (19 %) were stage IV. Among them, 277 (57 %) had disease recurrence. Median disease-free survival (DFS) was 16.4 months [95 % confidence interval (CI) 15.7–27.2], and median overall survival (OS) was 72.0 months (95 % CI 43.0–not reached). In total, 454 (94 %) patients received adjuvant treatment, and 440 (91 %) received adjuvant chemotherapy. In multivariate analysis, stage III–IV disease, CA-125 level, and lymphovascular space invasion (LVSI) were significantly associated with shorter median DFS. Stage III–IV disease, performance status 2–4, ≥50 % myometrial invasion depth, and postsurgical residual tumor size >1 cm were significantly associated with shorter median OS. Conversely, pelvic lymph node lymphadenectomy was associated with improved DFS and OS. Conclusions: Stage, performance status, CA-125 level, LVSI, and myometrial invasion were associated with poor prognoses. Pelvic lymphadenectomy was associated with improved survival, and may be necessary for the surgical management of UCS.

AB - Background: Uterine carcinosarcomas (UCSs) are rare and aggressive tumors. The prognostic factors are not sufficiently known. Methods: We performed a multi-institutional, retrospective study of women with stage I–IV UCS, diagnosed between 2007 and 2012. Data obtained from medical records included demographic, clinicopathological, treatment, and outcome information. Results: A total of 486 patients (median age 65 years) were identified—224 (46 %) were stage I, 32 (7 %) were stage II, 139 (28 %) were stage III, and 91 (19 %) were stage IV. Among them, 277 (57 %) had disease recurrence. Median disease-free survival (DFS) was 16.4 months [95 % confidence interval (CI) 15.7–27.2], and median overall survival (OS) was 72.0 months (95 % CI 43.0–not reached). In total, 454 (94 %) patients received adjuvant treatment, and 440 (91 %) received adjuvant chemotherapy. In multivariate analysis, stage III–IV disease, CA-125 level, and lymphovascular space invasion (LVSI) were significantly associated with shorter median DFS. Stage III–IV disease, performance status 2–4, ≥50 % myometrial invasion depth, and postsurgical residual tumor size >1 cm were significantly associated with shorter median OS. Conversely, pelvic lymph node lymphadenectomy was associated with improved DFS and OS. Conclusions: Stage, performance status, CA-125 level, LVSI, and myometrial invasion were associated with poor prognoses. Pelvic lymphadenectomy was associated with improved survival, and may be necessary for the surgical management of UCS.

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KW - Prognostic factor

KW - Uterine carcinosarcoma

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